| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $25.12 | $25.12 | $25.12 | |
Hally Health
| Professional | $24.55 | $38.90 | $74.13 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $28.84 | $29.51 | $31.62 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |